When is a cough more than just a cough?

So, you have a cough. Besides being annoying (both to you and likely those around you), a cough can be a symptom of more serious conditions—especially if lingers for a long time, is accompanied by fever or other symptoms, or gets steadily worse.

But figuring out when your cough is due to allergies or another minor issue versus when it might be pointing to a more serious health concern can be tricky. Let’s discuss the characteristics of your cough, the different types of cough and the most common causes I see as a family medicine doctor.

How to figure out what’s causing your cough

Here are a few questions to ask yourself about your cough so you can get to the bottom of the cause. If you end up going to the doctor, knowing how to describe your cough can also help your doctor make a diagnosis and recommend treatment options.

• Is it wet or dry? A wet cough, one that brings up mucus, can mean the cough is coming from the lower respiratory tract (but not always). A dry cough, which may feel like there’s a tickle in your throat, often points to the upper respiratory tract.
• What color is the phlegm? Some say the color of the phlegm you cough up is not helpful, but I disagree. Opaque off-white, yellow or green phlegm is more often infectious but not always bacterial. Clear phlegm is typically due to allergies, not an infection.
• How long has it been going on? Did your cough just start, or has it been going on for weeks, months or years?
• Are you having any other symptoms? If you’re having symptoms that seem to coincide, that can be a helpful clue as to what’s behind your cough.
• When does your cough get worse or better? Make note of when your cough happens—when you’re exercising or moving around, after eating, only at night, all day long?

Causes of acute (or sudden) cough

An acute cough is a cough that pops up suddenly, not one that you deal with regularly. These are most commonly due to an upper respiratory infection, asthma, acute bronchitis, environmental allergy, sinusitis or pneumonia.

This is where a physical exam is very helpful. Your doctor can evaluate your overall health and look for clues as to what might be causing your cough. For example, wheezing may mean asthma, whereas rales and fever may indicate pneumonia. Evidence of drainage to the posterior pharynx can indicate a cold or allergy.

Causes of chronic cough

Cough can sometimes be due to chronic acid reflux. Occasionally, this may be the only presenting symptom. I look for this when the symptom occurs primarily after meals and at night. If you also have heartburn, this may be the cause of your cough.

Chronic cough can be more difficult to diagnose because the list of possible causes is lengthier. Potential causes include lung mass, pleural effusion (from irritation of the diaphragm), smoker’s cough, asthma, tuberculosis, unusual lung infections such as nocardia, pneumocystis and histoplasmosis, among many others.

If you have a chronic cough that won’t go away or that keeps coming back, don’t ignore it. Make an appointment with your doctor to rule out any serious causes and get relief.

When to go to the doctor for a cough

Most of the time, you can treat your cough at home with over-the-counter cough medicine, plenty of rest and fluids, cough drops and hot, steamy showers. But if you think your cough might be a symptom of a more serious condition like pneumonia, or if it doesn’t go away after a few weeks of home treatment, make an appointment with your doctor.

Additionally, if you experience any of the below symptoms, it’s time for a doctor’s visit:

• Your cough lasts longer than 8 weeks
• Coughing up blood
• Fever above 100.4°F (38°C)
• Too weak to talk or walk
• Severe dehydration
• Wheezing in addition to coughing

Next steps

Knowing this information about coughs can be helpful as you navigate your treatment options, but remember, anytime you’re not feeling well, your primary care or family medicine doctor is your best bet to get the right care—and quickly.

Don’t have a primary care doctor? Find a doctor near you or explore our virtual care options.